News: Moral distress and clinician burnout

Moral distress happens when healthcare workers feel unable to act according to their ethical beliefs due to rules or other pressures. This can lead to burnout and negatively impact patient care. Factors like hospital culture, family demands for treatments that may not help, and providing unnecessary treatments can all contribute to moral distress. Previous research found that doctors in training had different approaches to end-of-life care—some only recommended treatments they believed were beneficial, while others gave patients all possible options without guiding them. This study looks at how a doctor’s ethical approach affects their experience of moral distress.

This study is part of a larger project looking at why some patients receive aggressive medical treatment at the end of life. Researchers interviewed 16 doctor trainees from the U.S. and 14 from the U.K. to understand their experiences of moral distress when providing end-of-life care. The trainees were chosen to include different training levels and genders. The interviews were analyzed to find common themes.

Results showed that moral distress was more frequently described among physician trainees with a “best interest” approach, in other words they would recommend only the treatments they believe will help the patient. Doctors with an alternative “autonomy” approach – giving all possible options without making a recommendation – experienced less intense moral distress. This finding held true among both US and UK physician trainees. Many physicians with a “best interest” approach noted a gap between their assessment of what treatments were beneficial and the treatments that they were actually delivering. Conversely doctors felt less uncomfortable giving treatments that might not help if they knew it was what the patient wanted.

Rosenwohl-Mack, S., Dzeng, E. The Effects of Individual Ethical Frameworks on Clinician Moral Distress. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-09284-7

News: Global review urges focus on low- and middle-income countries

A major international study, “Quality Indicators and Patient Outcome Measures for Palliative Care in Cancer Patients,” has revealed significant global gaps in how the quality of cancer palliative care is measured. The review, involving experts from 10 countries and 13 institutions (including King’s College London, Indiana University, and the African Palliative Care Association), analyzed 41 studies and found that while patient outcome measures (POMs) such as symptom relief and emotional well-being are commonly used, quality indicators (QIs)—which assess care structure and processes—are underdeveloped, particularly in low- and middle-income countries. Over 90% of the studies originated in high-income settings.

Experts, including Dr. Eve Namisango, called for renewed focus on person-centered, high-quality palliative care, supported by better-defined and globally relevant indicators.

A WHO Evaluation Study led by Principal Investigator Professor Richard Harding, with co-authors Dr Mevhibe Hocaoglu and Dr Anna Peeler validated seven universal, patient-centered quality indicators—including pain, worry, weakness, mobility, appetite, need for help, and peace—across six culturally diverse countries. These indicators showed strong consistency and measurable impact across settings.

The review issued three major recommendations:

1. Establish a global repository of palliative care quality indicators and patient outcomes, hosted by an independent institution to promote standardization, clinical alignment, and research access.
2. Expand research in low- and middle-income countries, where the need for palliative care is greatest but evidence is scarce, to develop context-appropriate tools.
3. Foster innovation in research design—using ethically sound and practical models such as fast-track trials, action research, and mixed-method approaches—to better capture real-world patient and caregiver experiences.
    

Dr Eve Namisango (African Palliative Care Association) said:

 “The need for palliative care in low-middle income countries is high, the development of services must be underpinned by a person-centered approach and should be of high quality. Our study highlights an urgent need to invest in research on developing measures to assess and evaluate the process and structural aspects of the quality of care.”

Dr Mev Hocaoglu commented:
“Our review calls for globally relevant, person-centered indicators. The WHO study delivers the evidence that it is possible—and urgently necessary—to define and track quality based on what matters most to patients.”

Ng CPY, Hegyi M, Lewison G, Pastrana T, Namisango E, Cleary J, Hasties B, Kabisa E, Musau H, Spangenberg K, Ruiz P, Ali Z, Mallafre-Larrosa M, Polo A, Torode J, Aggarwal A, Sullivan R, Hocaoglu M. Quality indicators and patient outcome measures for palliative care in cancer patients: a systematic review. Ecancermedicalscience. 2025 Jun 20;19:1929. doi: 10.3332/ecancer.2025.1929. PMID: 40606950; PMCID: PMC12221262.